Changing attitudes toward the management of blunt splenic trauma in adults.

During the past decade, one of the most controversial issues in the surgical literature has been the question of what is the most appropriate management of splenic trauma. An increased understanding of the physiologic importance of splenic function must now be weighed against the life-threatening risk of exsanguinating splenic hemorrhage. In this article, postsplenectomy sepsis and mortality in adults and the selective management of blunt splenic trauma are discussed. Although the risks of postsplenectomy sepsis and serious infection are low, they do exist. A policy of individual assessment of cases is recommended when the merits of splenectomy versus those of splenic preservation are considered. Similarly, in cases of blunt splenic trauma, a policy of individual assessment is not only intellectually attractive but also safe, rational, and effective from a clinical standpoint. In selected cases of blunt splenic trauma, nonoperative management and splenorrhaphy are acceptable alternatives; however, in many instances splenectomy remains the most appropriate and only course of action.